Hip joint pain

Hip joint painAre specificunpleasant, hard-to-bear sensations caused by the pathology of the upper femur, acetabulum, nearby soft tissue structures, varying in intensity from weak to unbearable, in nature they can be dull, sharp, pressing, aching, bursting, piercing, etc. . Often they depend on the load, the time of day and other factors. The causes of pain are determined using x-rays, CT, MRI, ultrasound, arthroscopy, and other studies. Painkillers and limb rest are recommended until the diagnosis is made.

Causes of hip joint pain

Soft tissue injuries

The most common traumatic cause of pain is a contusion of the hip joint. It occurs with a lateral fall or direct impact, is manifested in moderate acute pain, which quickly becomes dull, gradually decreases, and in severe cases - weeks - disappears within a few days. The support is retained, the movements are somewhat restricted. Edema is found locally, bruising is possible.

Injuries to the ligaments of the hip joint are rare, most often the result of traffic accidents and sports injuries, accompanied by severe pain, sometimes - a crack (as if from tearing tissue). The pain subsides a little, then often increases again due to edema. Swelling from the joint extends to the groin, thighs.

The degree of dysfunction in the case of trauma to the ligamentous apparatus depends on the severity of the injury (stretch, tear, rupture) and ranges from a slight restriction to the inability to support the leg. The pain increases with the deviation of the trunk, movements in the direction opposite to the damaged ligament.

Bone and joint injuries

Hip fractures usually occur in the elderly as a result of home or street trauma. A characteristic feature, especially with osteoporosis, is the absence of an intense pain syndrome, mild edema. At rest the pain is deep, dull, moderate or insignificant, with movements the painful sensations increase sharply. The support is sometimes retained. A common symptom is the inability to lift a straight leg from the prone position (a symptom of a stuck heel).

Transtrochanteric fractures are more commonly diagnosed in middle-aged and young people and develop as a result of high-energy trauma. Unlike cervical fractures, they are accompanied by excruciating sharp diffuse deep pain. Then the pain subsides but remains very strong, difficult to take. The joint is swollen and bruising is possible. Movement is severely restricted. Support is impossible.

Isolated fractures of the greater trochanter are rare; they occur in children and adolescents; they are caused by a fall, direct impact, or a sharp muscle contraction. The pain is acute, very intense, and localized mainly on the outer surface of the joint. Due to the increased pain, the patient avoids active movements.

Hip dislocations occur with falls from a great height, work and road traffic injuries, which are expressed in unbearable sharp pain that almost does not subside until reduction. The joint is deformed, the leg is shortened, bent at the knee joint, turned outwards, less often inwards (depending on the type of dislocation). Support and movement are impossible, the spring resistance is determined when trying to move.

Acetabular fractures develop in isolation or are combined with hip dislocations. Characterized by acute explosive pain in the depths of the hip joint. Then the pain subsides a little, but remains intense and hinders any movement. The leg is shortened, turned outwards. Support is impossible.

Degenerative processes

With coxarthrosis in the initial stage, the pain is periodic, dull, of uncertain localization, occurs at the end of the day or after significant exertion, and sometimes radiates to the hip and knee joint. Slight, quickly passing stiffness is possible at the beginning of the movements. Subsequently, the intensity of the pain increases, painful sensations are noted not only when moving, but also at rest. After vigorous exertion, the patient begins to limp. Movement is somewhat restricted.

In severe coxarthrosis, the pain is deep, diffuse, constant, painful, twisting. Disturb both during the day and at night. Resistance to stress is reduced and patients lean on a walking stick when walking. Movement is significantly restricted, the affected leg is shortened, which leads to increased stress on the joints and increased pain when walking and standing.

Chondromatosis of the hip joint resembles subacute arthritis in its course. The pain is moderate, diffuse, temporary, combined with crunching, restricted mobility. If the intra-articular body is injured, blockages appear, which are characterized by severe stabbing pain, impossibility or significant restriction of movement. After the injury to the joint mouse is over, the listed symptoms will disappear.

Trochanteritis is usually formed with osteoarthritis of the hip joint, accompanied by an inflammatory-degenerative lesion of the tendons of the gluteal muscles in the place of their attachment to the greater trochanter, which is manifested by pain in the area of the lesion in the supine position on the affected side. When trying to reduce the hip with resistance, the pain increases.

Nutritional disorders of the bones

Perthes disease develops in children and adolescents, is characterized by partial femoral head necrosis, which is initially accompanied by a non-intense dull deep pain that sometimes radiates to the knees and hips. After a few months the pain intensifies sharply, becomes constant, sharp, exhausting. The joint swells, mobility is restricted and lameness occurs. Then the pain decreases, the degree of restoration of joint functions varies.

Aseptic femoral head necrosis downstream is similar to Perthes disease, but it is detected in adults, proceeds less favorably, in half of the cases it is bilateral. At first the pain is periodic and pulls. Then the pain syndrome intensifies, occurs at night. At the height of clinical manifestations, the pain is so intense that the person loses the ability to support himself on the leg. Then the pain gradually subsides. Movement restrictions for about 2 years, the consequences are hip joint arthrosis, contractures and shortening of the extremities.

In boys aged 10-15 years, individual bone cysts form in the proximal metaphysis of the thigh, accompanied by non-intense intermittent pain in the hip joint. Edema is usually absent, and contractures often develop over time, especially in young children. Due to mild symptoms, the cause of treatment is a pathological fracture or increasing mobility impairment.

arthritis

Aseptic arthritis is characterized by wave-like pain in the joint that increases in the morning hours. The severity of the pain varies from insignificant to acute, severe, constant and significantly restricts physical activity. Stiffness, swelling, redness and an increase in local temperature are noted. Palpation is painful.

In rheumatoid arthritis, the hip joints are rarely affected, the lesion is symmetrical. Periodic pain first appears against the background of the change of seasons (autumn, spring), with sharp changes in weather, during periods of hormonal changes after childbirth or during the menopause. The pain is moderate or weak, diffuse, pulling or painful, sharply increased on palpation. It is combined with recurrent synovitis, edema, hyperemia, hyperthermia and increasing mobility impairment.

Infectious arthritis develops with hematogenous or lymphogenic spread of the infection, less often - with the penetration of the pathogen into the joint from nearby tissues. Typically acute onset with rapidly increasing pain. The pain is intense, twitching, tearing, bursting, disturbing at rest, aggravated by movement, as a result of which the extremity assumes a forced position. Patients have fever, chills, sweating, severe weakness, edema, reddening of the joint, and an increase in local temperature.

Without timely treatment, bacterial infectious arthritis can turn into panarthritis - a purulent inflammation of all tissues of the hip joint. It is characterized by a severe course with very acute, widespread throbbing pain, hectic fever, severe weakness, presyncope, marked hyperemia and hyperthermia.

Other inflammatory diseases

Thigh osteomyelitis can be haematogenic, post-traumatic, or post-operative. Haematogenic osteomyelitis manifests itself in clearly localized, very acute bursting, twitching, tearing or drilling pains, whereby the patient avoids the slightest limb movements. There is pronounced hyperthermia, severe intoxication.

Post-traumatic and post-operative osteomyelitis occur with similar but less pronounced symptoms. Typically, a more gradual onset against the background of an open fracture or postoperative wound, the appearance of purulent discharge. The pain in the hip joint increases within 1-2 weeks in line with the progression of signs of local inflammation.

Synovitis develops against the background of injuries, other diseases of the hip joint, less often it becomes a manifestation of allergies. With acute synovitis, the pain is usually mild, dull, bursting, and gradually increases due to an increase in intra-articular fluid. The joint is swollen, palpation is slightly painful, a symptom of fluctuation is noted. Chronic synovitis is asymptomatic and is accompanied by mild pain.

With intermittent hydroarthrosis, the pain is also insignificant, accompanied by discomfort, limited mobility and disappears within 3-5 days after the reverse resorption of the effusion. They renew themselves at regular intervals, individually for each patient, through repeated accumulations of fluid in the joint.

Specific infections

Hip joint tuberculosis is a common form of osteoarticular tuberculosis that manifests itself with general weakness, fatigue, and subfebrile condition. Then there is weak pulling or sore pain in the muscles, temporary painful sensations in the joint when walking. The patient begins to spare the limb. As the pain progresses, they become moderate, diffuse, radiate to the knee, supplemented by swelling, redness and synovitis. A protective contracture arises.

Joint pain, including the hip, can occur with brucellosis. In acute and subacute form, painful pulling, twisting, combined with periodic fever, lymphadenopathy, rashes. With a chronic course, the pain syndrome is similar to that of aseptic arthritis, over time malformations form.

Congenital abnormalities

The manifestations of hip dysplasia are determined by the degree of incongruity between the femoral head and acetabulum. With complete congenital dislocation, pain appears immediately after the child begins to walk, accompanied by lameness. With moderate subluxation, painful sensations appear at the age of 5-6 years, which are directly related to the load on the leg.

With a slight subluxation, the pathology is asymptomatic for a long time, the pain syndrome manifests itself with the development of dysplastic coxarthrosis at the age of 25-30 years. Characteristics of such osteoarthritis are the rapid increase in pain, early pain at rest and at night, and progressive restriction of movement. All forms of dysplasia are associated with an asymmetry of the skin folds, the "click" symptom and limited mobility. In the event of a dislocation, a shortening of the limbs is noted.

Neoplasms

A typical asymptomatic course in benign neoplasms. The pain is minor, intermittent and often does not progress over the years. The growth of the tumor is accompanied by a slow increase in the pain syndrome, recurrent synovitis. In the area of the hip joint, osteomas, osteoid osteomas, osteoblastomas, and chondromas are more frequently detected.

Malignant neoplasms (osteosarcomas, chondrosarcomas) are characterized by the rapid progression of the pain syndrome and other pathological manifestations. The pain is slight at first, short-term, without specific localization, sometimes worse at night. Then they become sharp, permanent, cutting, enclosing and spreading to the entire joint. The affected area is swollen, deformed. Weight loss, weakness, subfebrile condition are noted. In advanced neoplasms, painful, unbearable pain is only relieved with anesthetics.

Different reasons

Pain in the hip joint sometimes occurs with lumbosacral plexitis and sciatic nerve neuropathy, but usually occupy an insignificant position in the clinical picture, taking a back seat compared to severe pain on the buttocks and back of the thighs, weak limbs and sensory disorders.

A pain syndrome of this localization is often noted with osteochondrosis and herniated disc. Pain can be noted with spondylitis, deforming spondyloarthrosis, and curvature of the spine. The pain is dull, intermittent, achy, and often intensifies during the exacerbation of the underlying disease. The cause of their occurrence can be constant overloading of the joint or the development of coxarthrosis.

Sometimes joint pain is caused by a mental illness or a depressive disorder. Diabetes mellitus is often accompanied by enthesopathies, capsulitis, and other lesions of the periarticular soft tissues. Possible arthropathy when taking certain medications.

diagnosis

In the event of injuries, diagnostic measures are carried out by traumatologists. Degenerative and inflammatory diseases are treated by orthopedists and rheumatologists. With purulent processes, the involvement of surgeons is required. The examination includes the collection of complaints, the study of the anamnesis, the physical examination, additional research. Taking into account the peculiarities of the pathological process, the following methods can be used:

• Radiography.It is the basic technique for most joint diseases. Detects fractures, dislocations, changes in the contours of the acetabulum and the femoral head, marginal and intraosseous defects, bone growth, narrowing of the joint space.
• Ultrasonic.Most informative when examining soft tissues. Shows signs of inflammatory and degenerative processes, calcifications. For diagnosing effusion, joint mice.
• MRI and CT.Clarification techniques are used for ambiguous data from basic studies to clarify the type, prevalence and location of the pathological focus. Can be done with contrasting.
• Puncture of the joint.Has a diagnostic or therapeutic and diagnostic character. Allows you to remove effusion, study the composition of intra-articular fluid and determine the causative agent of infection using laboratory tests.
• Arthroscopy.During a visual examination of the joint, the doctor assesses the condition of the bone and soft tissue structures, if necessary takes a biopsy for a later histological examination and carries out therapeutic measures.
• Laboratory tests.They are prescribed to determine signs of inflammation and markers of rheumatological diseases, assess the general condition of the body, the activity of various organs in severe infectious or systemic pathologies.

treatment

Help before diagnosis

In the case of severe injuries, it is necessary to fix the joint by placing a splint from the foot to the armpit. In the case of minor traumatic injuries, it is sufficient to give the leg rest. Cold is applied to the affected area. If the pain is severe, an analgesic is given. You can not make active movements with the limb, put weight on the leg. It is strictly forbidden to try to get rid of the dislocation or displacement of the bones.

The tactics for non-traumatic diseases are determined by symptoms. With minor manifestations, it is permissible to ensure the rest of the limb to use local remedies with analgesic and anti-inflammatory effects. In the case of fever, weakness, severe pain, rapid edema growth and hyperemia, it is recommended to seek specialized help immediately.

Conservative therapy

Dislocations are an indication for immediate reduction. Skeletal traction is usually used for fractures, then surgery is performed or the limb is held in place with a plaster cast if there are signs of callus. In elderly patients with hip fractures, immobilization is permitted with a derotation boot that prevents rotational movement in the joint.

The rest of the patients are advised to relieve the hip joint. Depending on the indication, the use of orthoses or additional devices (crutches, walking sticks) is recommended. Prescribe massages, physical therapy exercises, physical therapy procedures:

• Laser therapy;
• Magnetic therapy;
• UHF;
• Ultrasonic;
• Electrophoresis with drugs;
• UHT.

It is possible to use NSAIDs, chondroprotectors, antibacterial drugs. Local agents are common. Depending on the indication, joint punctures, intra- and periarticular blockades with hormones, intra-articular injections of chondroprotectors, synovial fluid replacement are carried out.

surgery

Operations on the hip joint are openly accessible and carried out with the help of arthroscopic devices. Taking into account the nature of the pathology, the following can be done:

• Traumatic injuries:open reduction of the hip dislocation, reconstruction of the acetabulum, osteosynthesis of the neck, trochanteric fractures.
• Degenerative processes:Arthrotomy, arthroscopy, removal of free intra-articular bodies.
• Tumors:Removal of neoplasms, bone resection, disarticulation of the hip joint, Io-abdominal amputation, Io-abdominal resection.

For contractures, ankylosis, scarring of the periarticular tissue, redressing, arthroplasty, and arthrodesis are performed. Endoprosthetics are an effective means of restoring limb functions in diseases of various origins that are associated with restricted mobility or joint destruction.